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EDITORIALS: John Chisholm Primary care and the NHS white papers BMJ 1998; 316: 1687-1688 [Full text]

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GMSC misses opportunity to lead general practice through NHS reforms

Nicholas Steel   (9 June 1998)

GMSC misses opportunity to lead general practice through NHS reforms 9 June 1998
Nicholas Steel, Health Services Research Fellow School of Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ Send response to journal: Re: GMSC misses opportunity to lead general practice through NHS reforms	The Editor BMJ BMA House Tavistock Square London WC1H 9JR 8 June, 1998 Dear Sir, GMSC misses opportunity to lead general practice through NHS reforms John Chisholm elegantly summarises the current proposals for NHS reform in primary care1, but is vague about the General Medical Services Committee's "urgent negotiations" with the Minister for Health. Is he vague because his key outstanding issues for general practitioners conflict with the government's proposals for reform, which he rightly says have secured wide endorsement from both the public and health professions? There is clearly a tension between protecting the budget for the infrastructure of general practice on the one hand, and distributing resources more equitably and eliminating two tierism on the other. Or between insisting on general practitioners leading governing boards, and integrating social services into a fairer service based on cooperation. Or between protecting GP status as independent contractors, and reinstating strategic planning and involving the public. Individual freedom to prescribe and refer may need to be negotiable in a needs-led service addressing health inequalities. To recycle his own words, it is apparent that Chisholm's commitment to the GMSC exceeds his commitment to the recreation of a national service. His tribal defence of the traditional structure of general practice is essentially incompatible with the government's proposed reforms. If he just wants more gold for general practice, he needs to find a latter-day Bevan to put it in the appropriate place. If he wants a more equitable and integrated service, he should tell general practitioners what this will mean for them and offer the leadership through the reforms that general practice desperately needs. Yours sincerely, Dr Nicholas Steel MRCGP Reference 1. Chisholm J. Primary care and the NHS white papers. The right principles but bedevilled by the detail. BMJ 1998;316:1687-88